Laparoscopic surgeries are performed by inserting laparoscopic tubes and sleeves into the body through small incisions. Various instruments and a video camera (laparoscope) are then introduced into the body via the tubes and sleeves for performing and monitoring the surgery. The laparoscope and instruments allow the surgeon to explore the entire body cavity without making large standard openings, dividing skin and muscle, to access the cavity. The tubes and sleeves have diameters in the order of 10 millimeters and, thus, laparoscopic procedures require only small incisions to access the surgical site. These incisions significantly reduce the trauma and the required healing compared to traditional surgery, resulting in decreased hospitalization and patient morbidity, lower analgesic dosages for pain control, better aesthetic results and faster recovery. Such procedures can be used in a wide variety of procedures, such as urologic, gynecological, chest and abdomen surgeries.
For example, in a conventional laparascopic technique on the abdomen, a Veress needle is first inserted through the patient's abdominal wall and gas, usually carbon dioxide, is then injected through the needle to pressurize the abdominal cavity and distend the abdominal wall (insufflation). A pressure regulator gas insufflator is typically connected to the needle so that the pressure obtained does not go beyond 15 mmHg. Five or six small (5-10 mm) incisions are then made in the abdomen. The laparoscope and surgical instruments are inserted through these incisions, typically through laparoscopic tubes and sleeves, into the inflated abdominal cavity. The surgeon is then guided by the laparoscope, which transmits a picture of the internal organs on a video monitor.
Due to its complexity, however, laparoscopic surgical complications correlate highly to the level of surgeon experience (W. A. Cooper, C. S. Fischer, R. J., Predictors of laparoscopic complications after formal training in laparoscopic surgery, JAMA, 270: 2689, 1993). Further, the difficulty of laparoscopy in general, the high complexity of urological applications, and the relatively infrequent incidence of urologic cases make it essential for urologists to have access to specialized training programs. To meet this demand, numerous urologic laparoscopy programs and short courses have been established (Fahlenkamp, D., Rassweiler, J., Fornara, P. et al., Complications of Laparoscopic Procedures in Urology: Experience with 2, 407 Procedures at 4 German Centers, Journal of Urology, 162: 765, 1999). Training programs use a sequence of theoretical, simulator and animal training followed by mentored surgery, whereas short courses address only the first three of these steps. Laparoscopy simulators can be classified as either physical devices of various construction or virtual reality (VR) simulators.
Traditional training devices present box architecture with flexible trocar entry ports. For example, a box trainer designed for basic inverted-motion laparoscopy training was developed (Muhgal, M. A cheap laparoscopic surgery trainer, Ann R Coll Surgery, England, 74: 256, 1992). Box trainers that allow trocar placement and abdominal insufflation were also reported (Monro, A., Park, K., Atkinsori, D. et al., A laparoscopic surgical simulator, J. R. Coll. Surg. Edimb., 39: 176, 1994; Kopchok, G., Cavaye, D., Klein, S. et al., Endoscopic Surgery Training: Application of an In Vivo Trainer and In Vivo Swine Model, Journal of Investigative Surgery, 6: 329, 1993). Seattle's Simulab Corporation, along with the University of Washington Center of Videoendoscopic Surgery, provide a simulator with the purpose of replacing live-animal training. This simulator comprises a synthetic body model and procedure-specific packs and allows trainees to introduce surgical instruments and practice laparoscopy skills on simulated latex organs with standard instruments and laparoscopes. Specific procedure packs are available for general laparoscopic training in the initial phase for acquiring through-the-hole, inverted manipulation skills, depth perception under monitor vision, and hand-eye coordination, but fail to give a realistic anatomical perspective.
Recently, several virtual reality (VR) surgical simulators have become available. These trainers use a computer modeled human body and laparoscopic-like input devices (haptic interface) through which the trainee interacts with the model to perform specific surgical procedures. For example, MIST-VR is a laparoscopic trainer developed by Virtual Presence allowing the simulation of several laparoscopic procedures (Wilson, M. S., Middlebrook, A., Sutton, C. et al., MIST-VR: a virtual reality trainer for laparoscopic surgery assesses performance, Annals of the Royal College of Surgeons of England, 79: 403, 1997; Gallagher, A. G., McClure, N., McGuigan, J. et al., Virtual reality training in laparoscopic surgery: A preliminary assessment of minimally invasive surgical trainerreality (MIST VR), Endoscopy, 31: 310, 1999). While VR simulators potentially can provide training alternative, their application and utility is presently limited due to the high complexity required to realistically model human organs (Kneebone, R. Simulation in surgical training: educational issues and practical implications, Medical Education, 37: 267, 2003; Ahlberg, G., Heikkinen, T., Iselius, L. et al., Does training in a virtual reality simulator improve surgical performance? Surg Endosc, 16: 126, 2002).
The use of live animals, while more realistic with respect to tissue properties, is limited by its high cost and animal death rate, especially at the beginning of the learning curve. In addition, the use of a live animal provides a limited period of time within which to one can practice surgical skills. Still further, animals present different anatomy and organ situs than humans.
Various simulation approaches also have been employed in various imaging therapies and diagnostics, including for training and assessment of magnetic resonance imaging, various nuclear medicine therapies, and ultrasound procedures. Computerized Imaging Reference Systems, Inc. (Norfolk Va.) markets certain devices for those simulation applications.
It would be desirable to have new devices and methods for medical personnel residents to increase their level of experience in performing various surgical and imaging procedures including laparoscopic procedures.